Health disparities and chronic disease associated with anemia in free clinics: A retrospective study of uninsured patients in Tampa Bay

Postgrad Med. 2019 Nov;131(8):612-618. doi: 10.1080/00325481.2019.1668241. Epub 2019 Sep 22.

Abstract

Objectives: The objective of this study was to assess the diagnosis and management of anemic patients in free clinics around the Tampa Bay area.Methods: In this retrospective study we extracted data including demographics, chronic diseases, and laboratory values from medical charts of uninsured patients seen in 9 free clinics from January 2016 through December 2017 in the Tampa Bay area, FL, USA. Multiple logistic regression analysis was used to assess relationships between socioeconomic variables and a documented history of anemia.Results: From two years of documented data, 6971 patients were included, of which 367 (5%) had a documented diagnosis of anemia. Most were women (315, 86%), and the median age was 41 years (6-91). Among the 367 patients with anemia,191 (52%) patients had an unspecified type of anemia, 144 (39%) were diagnosed with IDA, 16 (4%) with anemia of chronic disease, and the remaining were other uncommon causes. Only 67% (97/144) of IDA patients had documented iron replacement. Colonoscopies were documented in only 32 (9%) of all patients with anemia, and in 23 (16%) IDA patients. Several chronic diseases were statistically associated and comorbid with a diagnosis of anemia.Conclusions: Uninsured patients with IDA are prescribed iron and undergo colonoscopies at sub-optimal rates. Increasing resources, awareness, and education of providers in these settings could lead to improved treatment practices and decrease the risk of morbidity and mortality.

Keywords: Anemia; colonoscopy; diagnostic medicine; health disparities; iron supplement; preventative health; public health; secondary screening; socioeconomic; uninsured.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anemia / epidemiology*
  • Anemia, Iron-Deficiency / drug therapy
  • Anemia, Iron-Deficiency / epidemiology
  • Child
  • Chronic Disease / epidemiology*
  • Colonoscopy / statistics & numerical data
  • Female
  • Florida / epidemiology
  • Health Behavior
  • Health Status Disparities
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Iron / therapeutic use
  • Logistic Models
  • Male
  • Medically Uninsured / statistics & numerical data*
  • Middle Aged
  • Retrospective Studies
  • Safety-net Providers / statistics & numerical data*
  • Socioeconomic Factors
  • Young Adult

Substances

  • Iron